Bronchiectasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations, prophylactic strategies, bronchodilator trial, and vaccination. The physiotherapy strategies focuses on airway clearance and pulmonary rehabilitation.
Bronchiectasis Medical Therapy
Medical Treatment
Patient Education
- The patients should understand their diagnosis clearly.
- Smoking cessation, regular exercise, and proper nutrition should be advised.
- The patient should know how to self-manage acute exacerbations with a home supply of antibiotics.
Treatment of Acute Exacerbations
- The mainstay of treatment is antibiotic therapy.
- Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended.
- Colonization with a particular microorganism is graded as chronic if the same microorganism is detected in three or more consecutive cultures separated by at least 1 month over a period of 6 months.[1]
- Oral antibiotic therapy should be used first line for 10-14 days. Intravenous (IV) antibiotics may be needed if there has been: no response to oral antimicrobials, systemic deterioration or if pathogenic organisms sensitive only to IV agents are cultured. [1]
- Here are suggested antibiotics with specific culture growth
- H. influenza type B
- Amoxicillin 1 g tds × 2/52, Doxycycline 100 mg bd × 2/52
- If β-lactamase-positive strain, Augmentin 625 mg tds × 2/52
- P. aeruginosa
- Ciprofloxacin 750 mg BD × 2/52
- If no response or resistant to above, consider IV alternatives for 2/52: Ceftazidime 2 g tds × 2/52 IV, Tazocin 4.5 g tds IV or Meropenem 1 g tds IV
- S. pneumoniae
- Amoxicillin 1 g tds × 2/52
- M. catarrhalis
- Augmentin 625 mg tds × 2/52 or Ciprofloxacin 500 mg BD × 2/52
- S. aureus
- Flucloxacillin 1 g qds × 2/52
References
- ↑ 1.0 1.1 McDonnell MJ, Ward C, Lordan JL, Rutherford RM (2013). "Non-cystic fibrosis bronchiectasis". QJM. 106 (8): 709–15. doi:10.1093/qjmed/hct109. PMID 23728208.